SUSTENANCE: Development of a toolkit to improve poSt-operative feeding practices and nUtritional intake in patientS wiTh hEad and Neck cANCer undergoing surgEry with flap tissue reconstruction

In the UK, 12,400 people are diagnosed with head and neck cancer each year, of which 75% have surgery. This may involve removing parts of the mouth used for eating/drinking, such as the tongue. The surgeons will rebuild these by using tissue from another part of the body, such as the arm. This is called a ‘flap’. After surgery, patients do not eat or drink for six to twelve days, and nutrition is provided by feeding tube either through the nose or directly into the stomach. The type of tube placed, the timeframe for re-starting eating/drinking and when the tube can be removed depends on many factors. These include being able to confidently swallow enough food/drink safely (affected by the amount of swelling in the mouth) and local hospital policies for when tubes are removed. Generally, the surgeon and team decide this for each person. However, nose tubes are often removed as soon as eating/drinking has begun, and before patients can manage enough food/drink. This happens because these tubes can prevent going home in some hospitals. Previous research shows 40-72% patients do not eat/drink enough after surgery. Nutrition drastically affects recovery and is the third largest cost-save to the NHS. Good nutrition speeds up recovery, improves wound healing, survival, and wellbeing. Poor nutrition slows recovery, increases risks of infection and even death. We want to understand what factors help or stop patients restart eating/drinking enough so that feeding tubes can be removed at the right time. Also, we think some patients can eat/drink sooner. This will improve their nutrition and help swallowing muscles recover. We will conduct an observational cohort study to identify factors associated with restarting oral intake and nutritional adequacy and interviews and observations exploring patient experiences and staff perceptions and practices. Findings will inform development of a staff toolkit.